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WHEN TO CONSIDER GROWTH HORMONES By Chayim Y. Newmark, M.D., F.A.A.P. Every parent in the world wonders if their child’s growth is normal. Fortunately, we are able to answer this question. The most important aspect of any assessment growth involves following a child’s growth over time. The growth rate is a much more important assessment than the child’s actual height. Two same-aged children may be at exactly the same height, but have very different growth patterns. Having the height shift down from the 50th percentile to the 5th percentile is quite concerning; growing consistently at the 5th percentile is not concerning at all. Any child whose growth rate at any point is less than two inches per year deserves a thorough assessment by a pediatric endocrinologist. Additionally, any child with a height below the 3rd percentile should be evaluated and a final adult height calculation should be made. Preferably, this evaluation should occur promptly, before puberty even starts. An initial evaluation includes screening for general medical diseases such as celiac disease and inflammatory bowl disease. Often, these conditions result in poor growth before specific symptoms such as abdominal pain and abnormal bowel habits are noticeable. Thyroid function tests are performed to rule out hypothyroidism. Insulin-like growth factor 1 (IGF-1) is measured as a marker for growth hormone production. Children with low predicted final adult heights, growth rate, and/or IGF-1 values should be considered for growth hormone therapy. However, the cost of growth hormone is approximately $40,000 per year. In some cases this cost is covered by health insurance companies. Many pediatric endocrinologists begin their evaluation with a growth hormone stimulation test. However, current research indicates that over 90 percent of children, who meet FDA indications for growth hormone therapy, will have normal test results. Furthermore, a significant percentage of children may have different test results on different days, just due to chance alone. Many insurance companies use these tests as a primary means for deciding coverage eligibility for growth hormone therapy. At The Saint Barnabas Pediatric Specialty Center, we are very vigilant in our appeals for growth hormone therapy, and have a very high rate of third party coverage for those children who meet FDA-approved indications. However, some insurance companies explicitly exclude coverage for growth hormone therapy. PROVIDING HELP THROUGH CLINICAL TRIALS Saint Barnabas is currently participating in a study of a once-a-week growth hormone for severe growth hormone deficiency and is the top recruiting site in the nation for a study using growth hormone therapy for children whose height is significantly below the normal range. Recently, our Center also joined an intriguing study evaluating the effect of combining growth hormone with IGF-1 to improve growth by targeting two different points in the growth process. Growth evaluations and therapy are highly individualized to your child. Please discuss any concerns you may have about your child’s growth with his or her pediatrician. The Division of Pediatric Endocrinology and Diabetes at Saint Barnabas Medical Center specializes in the treatment of diabetes, thyroid conditions and hormone deficiencies in infants, children and adolescents. Dennis Brenner, M.D., Chayim Newmark, M.D., and Ellen Oppenheimer, M.D. can be reached through The Saint Barnabas Pediatric Specialty Center, located at the Saint Barnabas Ambulatory Care Center, 200 South Orange Avenue in Livingston, NJ; 973.322.7337. Complimentary childcare and valet parking are available. Date: October 23, 2009 Saint Barnabas Contact: Samantha Anton, 973-322-5425 [ top ] [ back to news index ] |
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